There are several things you can do to help make your
next ER visit, or your family member’s next ER
visit, a success. Of course the ER physician and nurse
will do everything possible to maximize the quality
of medical care and minimize the possibility of medical
errors. However, little has been offered to the general
public in terms of participating in medical care, choosing
the correct hospital, and influencing the outcome of
the medical experience. You can have a positive impact
on the outcome of your medical experience. The following
recommendations may help you become an important part
of the medical team:

Be proactive relative to your particular life situation.
If you live in a small town you may not have medical
alternatives. But those of you in medium to large towns
may have several choices as to where you could seek
health care. Call 911 for any acute emergency. However,
in most cases you will not need to call an ambulance,
and will be able to choose which hospital to drive to
for emergency services.

If you have young children, identify the best hospital
in your location for the care of children. Call all
the local hospitals and find out which has superior
pediatric services. For example, does the hospital
have a section of the emergency department dedicated
specifically to pediatrics? Does the hospital have
a pediatric intensive care unit? Does the hospital
have an orthopedic physician on staff that specializes
in pediatric broken bones? A hospital with these services
provides sophisticated pediatric care and may be the
optimal destination when your child is ill.

If you are in mid-life, you may require cardiac
services for a heart or other cardiovascular-related
problem. Not all hospitals are created equal. Recent
medical literature suggests that if you have a cardiac-related
problem you may be best served by hospitals with 24-hour
cardiac intervention services. This means that the
hospital has cardiologists present to perform cardiac
catheterization and angioplasty around the clock.
If these services are not available in your location,
you can be transferred to a hospital that does provide
them. But where the heart is involved, usually the
sooner the better. Transfers take valuable time that
you may not have. Again, be proactive and consider
these issues now, and identify the best hospital for
the treatment of symptoms that are cardiovascular
in nature.

Does your local hospital provide a full spectrum
of cardiac-related services? If angioplasty does not
work to open up your coronary artery you may need
cardiac bypass surgery. You may be best served by
the local hospital with both interventionalist services
and cardiovascular surgical services. If interventional
procedures don’t work you can always be transferred
to another hospital for cardiac surgery. Why not be
an informed consumer of medical services and consider
these issues now? If you have the choice, consider
using the hospital that can provide a full array of
cardiovascular services.

Patients in mid to later life may be in need of
care for a stroke or stroke-like symptoms. In cases
of obvious stroke always call 911 for rapid access
to the local emergency medical system. You should
know that there are new therapies for stroke that
may stop or reverse the stroke process. In recent
years, studies have shown that clot-busting medications
called lytic agents may, in a small group of patients,
have a remarkable and potentially life-saving effect.
Again, not all hospitals are created equal. The lytic
medications can be remarkably helpful but can also
cause dangerous intracranial bleeding. Therefore,
these medications must be used according to a strictly
controlled regimen. Some hospitals are qualified to
use these medications for stroke and some are not.
Some hospitals are actually certified in stroke care
by the American Stroke Association and others are
not. When researching which of your local hospitals
are sophisticated in these various treatment areas,
ask whether the hospital is certified by the American
Stroke Association, or has a program to provide clot
busters to stroke patients. Ask whether the hospital
is a Primary or Comprehensive Stroke Center. Comprehensive
Stroke Centers can manage the entire spectrum of stroke-related
problems.

For those of you with students off to college, consider
the likelihood that within 4 years your young adult
family member may need to visit an emergency department.
If the problem does not require ambulance transport,
your child will probably have no idea where to go
or what to do. Find out what hospitals are close to
the school and explain what to do in case he or she
requires a trip to the ER.

There are several things to consider when presenting
to an emergency department for medical care. Always
bring your medications or a medication list with you,
and know what medical conditions you are being treated
for. However, your participation on the ‘team’
can go way beyond your medication list:

It is important to consider the human side of both
patient and physician in the face of an acute medical
problem. In looking at a large number of ‘failure
to diagnose’ cases, it is apparent that both
the patient and the physician ‘minimized’
the likelihood of serious disease. As a result, the
correct diagnosis was missed. For example, you may
seek emergency medical care after experiencing a pressure-like
feeling in your chest, which could be angina or a
heart attack. Patients often explain, “It just
feels like gas.” In fact, gas seems like a great
answer because you would rather have a gas-related
problem than a heart attack. The physician feels the
same way. The physician also hopes that you are having
a gas-related problem and may follow your lead toward
the wrong conclusion. But when was the last time you
went to the ER for gas? You can be an invaluable member
of the team by carefully describing the new feelings
you have developed. Don’t suggest conclusions
and do not minimize the feelings you are having. It
is critical that the ER physician has a complete understanding
of what you are experiencing.

There are times when the patient simply knows better
than the doctor. For example, if you have had a heart
attack before, you probably know if you are having
another one. Patients who have suffered from kidney
stones absolutely know when they are having another
attack. In one case reviewed by Dr. Sullivan a patient
said to the emergency physician, “I am having
a heart attack, it is just like my last one.”
The emergency physician disagreed and discharged the
patient. The patient thought the ER physician was
wrong but did nothing about it. Don’t let the
medical practitioner make that mistake. If you feel
that the physician is headed down the wrong path,
challenge him. If necessary get your family doctor
on the phone. Although this may not be welcome news
for many physicians, it is better to work through
a challenge right away than to miss or delay a diagnosis.

Your vital signs. During your emergency department
visit the nurse or physician will usually take vital
signs. Vital signs are just that – vital! For
most of your life your pulse, breathing, and blood
pressure will fall into a safe physiologic range.
A significant abnormality of one or more vital signs
can be an important marker of a serious medical problem.
Ask about your vital signs. If there is an abnormal
number ask the physician or nurse to explain the reason
for it. For example, your blood pressure may be elevated.
That may simply be because you are visiting an emergency
department! However, it may be related to a new onset
of hypertension and your blood pressure should be
rechecked at some later time. A pulse rate of 120
is very abnormal and you should not leave the ER without
having it rechecked to make sure it is back to normal.

Know your families’ medical history and your
own medical history. During your ER visit you may
be asked certain questions about your family and your
own medical history. If you have a simple laceration
this information is probably not relevant. But in
many cases it is. For example, if you present to a
hospital with chest pain, it is important to know
whether your parents suffered from heart attacks.
The ER doctor always needs to know if you are pregnant
because that is a risk factor for certain conditions,
such as blood clots. Your history of surgical procedures
may be critical to the current analysis of what is
wrong. Always be prepared to offer this information
when asked. If you are not asked, but you have important
family or personal medical history, offer that information
to the physician.

These suggestions can lead you down the road to better
health. The vast majority of emergency physicians and
nurses are highly qualified and competent in the provision
of emergency care. Remember that the ER environment
can be extremely hectic and overwhelming. You do not
want to be making critical decisions in such an environment
without having thought through the process beforehand.
While it is impossible to be prepared for all of life’s
contingencies, the vast majority of visits to the ED
would be improved if the patient and/or their family
members were better prepared.